Malaria and Vascular Endothelium

Filho, Aristóteles Comte de Alencar; Lacerda, Marcus Vinícius Guimarães; Okoshi, Katashi; Okoshi, Marina Politi

doi:10.5935/abc.20140088

Cited by 8 publications

(8 citation statements)

References 34 publications

(35 reference statements)

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“…9 This may allow the accumulation of infected erythrocytes in the myocardial capillaries, leading to mechanical obstruction, reduced tissue perfusion, and disease. 13,14 Although less common, studies have also demonstrated how P. vivax-infected erythrocytes also may adhere to the endothelium. 11,13,78 Likely, accumulation in the capillaries and microcirculation in the myocardium may result in regional dysfunction, leading to pathological alterations in ECG, biomarkers, and echocardiographic parameters.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Although less common, studies have also demonstrated how P. vivax-infected erythrocytes also may adhere to the endothelium. 11,13,78 Likely, accumulation in the capillaries and microcirculation in the myocardium may result in regional dysfunction, leading to pathological alterations in ECG, biomarkers, and echocardiographic parameters. Those are the same parameters that we found affected in a majority of clinical studies of P. falciparum patients on admission.…”

Section: Discussionmentioning

confidence: 99%

“…11 Although no studies have demonstrated cytoadherence of infected erythrocytes to the myocardial endothelium, autopsy data suggest that infected erythrocytes may block myocardial capillaries 12 consequently, leading to mechanical blood flow obstruction and potential myocardial ischemia. 13,14 Other proposed mechanisms involve release of parasite toxins causing apoptosis of cardiac myocytes 15 and impairment of vascular endothelial function, resulting in upregulation of pro-inflammatory cytokines and myocardial dysfunction. [16][17][18] At present, the pathophysiology between malaria and cardiac illness is not entirely understood, and an appraisal of the most common cardiovascular complications in the acute setting of malaria may prove beneficial to improve both treatment and prognosis of patients.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Cardiovascular Complications in Malaria: A Systematic Review and Meta-Analysis

Gomes

Marinho

Silvestre

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Recent studies have suggested that malaria may affect the cardiovascular system. The aim of this systematic review and meta-analysis was to determine the prevalence of cardiovascular complications in symptomatic malaria patients. We searched databases such as Pubmed, Embase, Cochrane, and Web of Science (January 1950–April 2020) for studies reporting on cardiovascular complications in adults and children with malaria. Cardiovascular complications were defined as abnormalities in electrocardiogram (ECG), cardiac biomarkers, and echocardiography on admission or during outpatient examination. Studies of patients with known heart disease or cardiovascular evaluation performed after the start of intravenous antimalarial medication were excluded. The study was registered in PROSPERO (No.: CRD42020167672). The literature search yielded 1,243 studies, and a total of 43 studies with symptomatic malaria patients were included. Clinical studies (n = 12 adults; n = 5 children) comprised 3,117 patients, of which a majority had Plasmodium falciparum (n = 15) and were diagnosed with severe malaria (n = 13). In random-effects models of adults, the pooled prevalence estimate for any cardiovascular complication was 7% (95% CI: 5–9). No meta-analysis was conducted in children, but the range of abnormal ECG was 0–8%, cardiac biomarkers 0–57%, and echocardiography 4–9%. We analyzed 33 cases (n = 10 postmortem), in which the most common cardiovascular pathologies were myocarditis and acute coronary syndrome. All histopathological studies found evidence of parasitized red blood cells in the myocardium. Cardiovascular complications are not uncommon in symptomatic adults and children with malaria. Additional studies investigating malaria and cardiovascular disease are encouraged.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prevalence of Cardiovascular Complications in Malaria: A Systematic Review and Meta-Analysis

Gomes

Marinho

Silvestre

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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“…falciparum malaria [ 2 , 4 – 6 ]. After malaria infection, the endothelial cells can be activated by different mechanisms such as the binding of soluble cytokines, mediated by pro-inflammatory cytokines present in host serum [ 7 , 8 ], direct contact with infected RBCs, and activation induced by parasite-derived molecules such as hemozoin and glycosylphosphatidylinositol (GPI). These factors can induce endothelial injury and apoptosis which lead to increase in vascular permeability.…”

Section: Introductionmentioning

confidence: 99%

Reduction in serum sphingosine 1-phosphate concentration in malaria

Punsawad

Viriyavejakul

2017

PLoS ONE

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Sphingosine 1-phosphate (S1P) is a lipid mediator formed by the metabolism of sphingomyelin which is involved in the endothelial permeability and inflammation. Although the plasma S1P concentration is reportedly decreased in patients with cerebral malaria, the role of S1P in malaria is still unclear. The purpose of this study was to examine the impact of malaria on circulating S1P concentration and its relationship with clinical data in malaria patients. Serum S1P levels were measured in 29 patients with P. vivax, 30 patients with uncomplicated P. falciparum, and 13 patients with complicated P. falciparum malaria on admission and on day 7, compared with healthy subjects (n = 18) as control group. The lowest level of serum S1P concentration was found in the complicated P. falciparum malaria group, compared with P. vivax, uncomplicated P. falciparum patients and healthy controls (all p < 0.001). In addition, serum S1P level was positively correlated with platelet count, hemoglobin and hematocrit levels in malaria patients. In conclusions, low levels of S1P are associated with the severity of malaria, and are correlated with thrombocytopenia and anemia. These findings highlight a role of S1P in the severity of malaria and support the use of S1P and its analogue as a novel adjuvant therapy for malaria complications.

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“…Colomba et al reported similar findings in a malaria case and suggested that local inflammation might increase vascular permeability, leading to accumulation of pericardial fluid [ 6 ]. Other suggested mechanisms include cytoadhesion of infected erythrocytes to the coronary endothelium [ 17 ] and release of pro-inflammatory cytokines due to vascular endothelial dysfunction in the myocardial vessels [ 18 , 19 ]. Despite a plethora of proposed mechanisms, no consensus exists as to how malaria affects the heart.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary alterations by ultrasound in a patient with uncomplicated mixed malaria infection: a case report from the Amazon Basin

Wegener

Lima

Gomes

et al. 2021

Malar J

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Background Information on cardiopulmonary complications in clinical malaria is sparse and diagnosis may be difficult in resource-limited areas due to lack of proper diagnostic tools and access to medical care. A case of pericardial effusion and pulmonary alterations assessed by ultrasound in a patient with uncomplicated mixed malaria infection is described. Case presentation A previously healthy 23-year-old male from the Amazon Basin was diagnosed with mixed infection of Plasmodium vivax and Plasmodium falciparum by peripheral blood smear. The patient presented with mild malaria symptoms without signs of severe malaria, but reported moderate chest pain and shortness of breath. Laboratory analyses revealed thrombocytopenia and anemia. The electrocardiogram had PR depressions and bedside ultrasound of the cardiopulmonary system showed pericardial effusion (18 mm) accompanied by multiple B-lines in the lungs, identified as vertical artifacts extending from the pleural line. Cardiac biomarkers were normal. The patient was treated according to national guidelines for malaria and suspected pericarditis, respectively. At follow-up on day 5, the pericardial effusion (9mm) and B-lines had markedly decreased. By day 21 the patient was asymptomatic, had completed the treatment, and the electrocardiogram and ultrasound findings had normalized. Conclusions This case report highlight the usefulness of bedside ultrasound to identify cardiopulmonary involvement in patients with uncomplicated malaria and relevant symptoms.

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Malaria and Vascular Endothelium

Cited by 8 publications

References 34 publications

Prevalence of Cardiovascular Complications in Malaria: A Systematic Review and Meta-Analysis

Prevalence of Cardiovascular Complications in Malaria: A Systematic Review and Meta-Analysis

Reduction in serum sphingosine 1-phosphate concentration in malaria

Cardiopulmonary alterations by ultrasound in a patient with uncomplicated mixed malaria infection: a case report from the Amazon Basin

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